Urban Institute: Implications of Partial Repeal of the ACA through Reconciliation

By Clive Riddle, December 9, 2016

CNBC called it the Obamacare Doomsday Scenario: the Urban Institute has released a 33-page brief - Implications of Partial Repeal of the ACA through Reconciliation - examining what would happen if the new congress goes forward with an ACA partial repeal with a replace to be named later – using a reconciliation bill similar to one President Obama vetoed in January 2016. Their analysis determined that “the number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).”

The Urban Institute points out that “there is currently no consensus around alternative health policies to enact as the ACA is repealed; consequently, partial repeal via reconciliation without replacement is possible and merits analysis.” The scenario they lay out is that “Congress is now considering partial repeal of the Affordable Care Act (ACA) through the budget reconciliation process. Since only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates; it would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place.”

Here’s some highlights from their report of what is in store for us if the scenario takes place:

  • The share of nonelderly people without insurance would increase from 11% to 21%
  • 22.5 million people will become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate
  • An additional 7.3 million people will become uninsured because of the near collapse of the nongroup insurance market.
  • 82% of the people becoming uninsured would be in working families, and 80% of adults becoming uninsured would not have college degrees.
  • 38% becoming uninsured would be ages 18 to 34, and 56% would be non-Hispanic whites.
  • There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
  • Approximately 9.3 million people who would have received tax credits for private nongroup health coverage in 2019 would no longer receive assistance.
  • Federal healthcare spending would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.
  • State spending on Medicaid and CHIP would decrease $76 billion between 2019 and 2028.
  • The newly uninsured would seek an additional $1.1 trillion in uncompensated care at the state/local level between 2019 and 2028.
  • The 2016 reconciliation bill did not increase funding for uncompensated care beyond current levels.
  • If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016 and eliminates the individual and employer mandates immediately, in the midst of an already established plan year, insurers would suffer substantial financial losses (about $3 billion); the number of uninsured would increase right away (by 4.3 million people); at least some insurers would leave the nongroup market midyear.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, December 9, 2016

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

1. 5 quick ways a new HHS secretary could change health policy
Kaiser Health News reports: Prospective Health and Human Services secretary Tom Price, currently the chairman of the House Budget Committee, brings a distinctive to-do list to the agency. And, if confirmed by the Senate, he will have tremendous independent power to get things done.
Kaiser Health News via the Washington Post, December 9, 2016

2. HHS Chief Warns Senate Democrats of ‘Chaos’ Under ACA Repeal
Morning Consult reports: The nation’s top health official spoke with Senate Democrats Thursday about the repeal of the Affordable Care Act, warning that undoing the law without having a replacement ready could be disastrous.
Morning Consult, December 8, 2016

3. These drug price hikes cost taxpayers millions
Stat News reports: Drugs to treat cancer, high blood pressure, and seizures experienced large price spikes in 2015, costing taxpayers millions of dollars in added Medicare spending, according to new data released by the federal Centers for Medicare and Medicaid Services.
StatNews, December 8, 2016

4. Health Insurers List Demands if Affordable Care Act Is Killed
The NY Times reports: The nation’s health insurers, resigned to the idea that Republicans will repeal the Affordable Care Act, on Tuesday publicly outlined for the first time what the industry wants to stay in the state marketplaces, which have provided millions of Americans with insurance under the law.
New York Times, December 6, 2016

5. Insurers’ Flawed Directories Leave Patients Scrambling For In-Network Doctors
Kaiser Health News reports: Penny Gentieu did not intend to phone 308 physicians in six different insurance plans when she started shopping for 2017 health coverage.
Kaiser Health News, December 5, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Focus on Value to Survive, Maybe Flourish, for Next Four Years

by Clive Riddle, December 2, 2016

What shall be the fate of value-based care initiatives in the wake of a new administration’s zeal to slash away at all thing Affordable Care Act? The following article: Focus on Value to Survive, Maybe Flourish, for Next Four Years, recently appeared in the Inaugural issue of Value-Based Payment News, Russell Jackson, editor:

The quadrennial change of who’s who in the nation’s capital generally brings with it a shift in focus at the federal regulatory agencies and a reboot of the dynamic between the White House and the Capitol. But despite the magnitude of change that could reverberate throughout the national-level political apparatus this time around, experts pretty much agree that the value- and quality- and other payment reform-related programs – the Medicare Access and CHIP Reauthorization Act included – will likely continue in much their current form, albeit, in some cases, under different names and with, in all likelihood, different, and surprising, claims of original ownership.

Don’t be surprised, in other words, if a newly named Centers for Medicare and Medicaid Innovation turns out to have been the new president’s idea all along. Here’s a sampling of what the policy experts have been telling the press about value-based healthcare programs for the next four years.

“Premier Senior Vice President Blair Childs says Republicans strongly support Accountable Care Organizations. ‘They first ran the ACO demonstrations under the Bush Administration,’ he said by email. ‘They are envisioned in MACRA, of which the Republicans are strong supporters.’”

== ‘Republicans Expected to Spare ACOs, Other Demos from ACA Repeal;’

“Ian Spatz, a senior advisor at Manatt Health, said there is no reason to think Republicans would reverse the trend toward providers sharing risk. He said ACOs and other demonstrations that move away from the fee-for-service system are not partisan. However, Spatz said it’s likely that Republicans will place restrictions on CMMI, such as prohibiting mandatory demonstrations, and they might change the Centers’ name.”

== same article

Gilberg, senior vice president of government affairs for the Medical Group Management Association, said they are advising members to continue preparation for MACRA. ‘We don’t see that that is going to be repealed. It was bipartisan, nearly a unanimous vote.’”

== ‘MACRA will move forward largely untouched when Trump steps in, experts say;’

 “Christopher Kerns, managing director at The Advisory Board, said, ‘MACRA is not in trouble, but mechanisms by which they control spending could change.’ Kerns said there might be a shift away from ACOs as a principal driver of controlling spending, and more toward bundled payments or price controls, cuts or other forms of utilization control in the form of reduction in reimbursement for different kinds of services.”

== same article

“The American Academy of Family Physicians said [it doesn’t] believe MACRA as a whole is in any real danger of repeal. ‘The election of Mr. Trump will have a limited impact on the MACRA law in the short-term,’ said AAFP President John Meigs Jr. ‘Looking forward, this law was supported by 91% of Congress. Based on the bipartisan support, it is difficult to see how there would be any fundamental changes under the Trump Administration.’”

== same article

“’This is a movement that’s happening independent of the ACA, or parallel to it,’ said David Jones, an assistant professor of health law, policy and management at Boston University’s School of Public Health. ‘It’s very unclear when they say they’re going to repeal ObamaCare whether they’re even thinking about things like CMMI or to shift away from things like fee-for-service.’”

== ‘Will value-based payment initiatives continue under Trump?;’

On the other hand …

“House Budget Chair Rep. Tom Price (R-GA) has had CMMI in his sights for a while now, and Sen. Orrin Hatch (R-UT) is no big fan. Both claim the center lacks accountability and hasn’t shown clear results. They may try to eliminate mandatory CMMI payment models and could seek to legally trim its sails.”

== ‘CMS CMMI, ONC and AHRQ preparing to take hits;’


You can request a sample copy of Value-Based Payment News by going here:


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, December 2, 2016

1. The drug industry’s stake in Trumpcare is bigger than you think
StatNews reports: The upcoming fight over repealing and replacing the Affordable Care Act promises to shake up hospitals and insurers, but drug makers also stand to gain — or lose — a lot.
StatNews, December 2, 2016

2. 2,000+ physicians: 'The AMA does not speak for us' in supporting Price for HHS
Becker's Hospital Review reports: More than 2,000 physicians signed an open letter railing against the American Medical Association's support for Rep. Tom Price, MD, R-Ga., chairman of the House Budget Committee, as secretary of HHS.
Becker's Hospital Review, December 1, 2016

3. U.S. House Passes 21st Century Cures Legislation
Healthcare Informatics reports: The U.S. House of Representatives today passed sweeping, bipartisan legislation, called the 21st Century Cures Act, comprised of a $6.3 billion package of medical innovation bills including $4.8 billion to the National Institutes of Health as well as $1 billion in state grants to fight opioid abuse.
Healthcare Informatics, November 30, 2016

4. Price’s Appointment Boosts GOP Plans To Overhaul Medicare And Medicaid
Kaiser Health News reports: President-elect Donald Trump’s selection of Rep. Tom Price to head the Department of Health and Human Services signals that the new administration is all-in on both efforts to repeal the Affordable Care Act and restructure Medicare and Medicaid.
Kaiser Health News, November 29, 2016

5. CMS nominee set up Indiana’s unusual Medicaid expansion
The Washington Post reports: A decade ago, when Indiana had one of the lowest rates of health insurance coverage in the nation, then-Gov. Mitch Daniels (R) turned to a health policy consultant named Seema Verma to help insure more of the state’s poor and working poor.
The Washington Post, November 29, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, November 18, 2016

1. Study Finds Nearby Retail Clinics Don’t Drive Down ER Visits
Kaiser Health News Reports: Even if there’s a retail health clinic less than a 10-minute drive away, consumers are just as likely to go to the emergency department for low-level problems like bronchitis or urinary tract infections, a recent study found.
Kaiser Health News, November 18, 2016

2. The ultimate Q&A about health care under a Trump presidency
The Washington Post reports: While it's pretty much a given that the Affordable Care Act won't survive a Trump presidency and Republican Congress in its current form, there are sweeping implications of reversing a law that has reached in so many ways into our health care system.
The Washington Post, November 17, 2016

3. Former Valeant and Philidor Executives Charged in Kickback Scheme
The New York Times reports: A secret relationship had made the two men rich: one, the head of a mail-order pharmacy, the other, an executive at a major pharmaceutical company who had promised to funnel millions of dollars to his partner in exchange for receiving millions of his own.
The New York Times, November 17, 2016

4. Landmark report by Surgeon General calls drug crisis ‘a moral test for America’
The Washington Post reports: A landmark report released Thursday by U.S. Surgeon General Vivek H. Murthy places drug and alcohol addiction alongside smoking, AIDS and other public health crises of the past half-century, calling the current epidemic “a moral test for America.”
The Washington Post, November 17, 2016

5. More than 1 million sign up for ObamaCare, HHS says
The Hill reports: More than 1 million people have registered for ObamaCare coverage for 2017 since the sign-up period began Nov. 1, the Obama administration announced Wednesday.
The Hill, November 16, 2016

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.